Crtical Care and Shock Journal

National Survey of Acute Hypertension Management

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Background: National practice guidelines do not exist for the treatment of acute hypertension (AH) in the critically ill adult. An initial step towards guideline development is to document current prescribing patterns of intravenous (IV) antihypertensives for AH, which serves as the purpose of this survey.

Methods: An e-mail to participate in this Web-based survey was sent to 5574 critical care physician and pharmacist members of the Society of Critical Care Medicine and the American College of Clinical Pharmacy. The survey, which requested responses concerning antihypertensive management in the respondents’ intensive care unit (ICU), opened March 12, 2007 and closed May 11, 2007.

Results: Three hundred ninety three (7.1%) responses were returned; 25 were excluded. The most common practice setting (44.6%) was a mixed-population ICU. One hundred three (28.3%) respondents reported that a guideline exists in their institution for the treatment of hypertensive emergency (HE) in acute hemorrhagic stroke (AHS), while only 30 (8.2%) had guidelines for the non-stroke (NS) patient. Among physician respondents, mean systolic blood pressures (SBP) used to initiate IV antihypertensives were 180.9 (range 105-220) mm Hg and 167.2 (range 100-220) mm Hg in NS and AHS patients, respectively. In the NS patient, intermittent IV labetalol was the drug of choice among physicians (21.3%) and pharmacists (26.5%), while nicardipine was the drug of choice for the AHS patient (34.7%, 36.2% respectively). The second line agent of choice for the NS patient was sodium nitroprusside among physicians (19.8%) and continuous infusion labetalol for pharmacists (19.8%). For the AHS patient, the second line agent of choice was nicardipine among physicians (21.8%) and pharmacists (27.6%). One hundred thirty one (36%) respondents reported that they have seen a patient with symptomatic cyanide and/or thiocyanate toxicity.

Conclusions: Because most institutions do not have HE guidelines, our data described herein provides the rationale for developing a national guideline.

Jessica E. Benson, Anthony T. Gerlach, Joseph F. Dasta

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